title: Enhancing quality of primary care using an ambulatory ICU to achieve a patient- centered medical home.
abstract: OBJECTIVE
  The Patient-Centered Medical Home (PCMH) has been advocated as a model to address the lack of coordination and continuity in the health system. However, implementation in practice has been slow and incompletely described.
  
  
  METHODS
  Patients referred into the program received intensive nurse follow-up focused on medication adherence, care coordination, and education. Patients graduate from the program when treatment goals are met.
  
  
  METHODS
  The first 100 patients enrolled into the PCMH focused program of a primary care clinic in an urban, academic medical center. The main outcome measures are goal adherence and emergency room use.
  
  
  RESULTS
  Ninety percent of enrollees met the health goals set for them at enrollment. During their enrollment, 31.6% of patients with diabetes reduced and maintained their blood glucose readings; 24.6% of patients with hypertension reduced and maintained their blood pressure readings. Emergency department use in the time period following enrollment dropped 46.7%.
  
  
  CONCLUSIONS
  The ambulatory intensive care unit program showed an improvement in health outcomes and health care use.This program also helps to move the practice toward PCMH by centralizing care through a primary care provider, enhancing access to care, and by focusing on the patient holistically through rapport with a nurse.
  This care delivery method drives the clinic closer to the PCMH and toward the Accountable Care Organization (ACO) model.
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Joy
authors.initials: J
authors.lastname: Lewis
authors.forename: Alex
authors.initials: A
authors.lastname: Hoyt
authors.forename: Rose M
authors.initials: RM
authors.lastname: Kakoza
keywords: disease management; health outcomes; health promotion; impact evaluation; managed care; primary care